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Full text of "A discourse on the epidemic sore throat disease, sometimes called diptheria"

1 9 



-A. IDISOOXJI?.SE 

ON THSf 

Epidemic Sore Throat Disease, 



SOMETIMES CALLED 

DIPTHERIA. 



Ladies and Gentlemejs": 

A disease of a good deal of severity, partaking of 
an epidemic character, has for some time prevailed 
in this country, and among us. It is of that class 
which is not confined to cities or villiages, but one 
which also extends its influence over the rural dis- 
tricts. It is a disease calculated to arouse and excite 
the maternal feelings and sympathies by its being in 
a measure confined to the juvenile portion of the 
community. The force of the disease locates upon 
the organs of the throat. 

In endeavoring to fix on a general plan for treating 
a new or anomalous disease of an epidemic nature, it 
will be of great advantage to examine into the nature 
and character of voilent and epidemic diseases which 
have pi-evailed at forrner periods, so as to compare their 
symptoms with those attending the present malady, 
and to ascei'tain what mode of treatment had proved 
most successful to control the sypmtoms and to cure 
those affections; therefore it may be of advantage to 
take a brief review of some of the features of those 
diseases and notice the results of modes of treat- 
ment so as to more correctly fix on a method of treat- 
ment which may prove most successful for the 
present epidemic. 

All, oi" nearly all, of the epidemiQ diseases which 



?1 



have prevailed in this country, according to the his- 
tories of them, have heen of an inflammatory or com- 
pound inflammatory natui-e. An opinion is generally 
established that the most advisable and successful 
mode of treating such inflammatory and congestive 
diseases is, in the first stage of the cases to pretty 
freely use depleting refrigerant remedies. 

The epidemic quincy or sore throat disease now 
prevailing, seems to be of a highly inflammatory 
character. In this affection, as it has been in other 
voilent and epidemic diseases, those cases which are 
the most voilent in their attacks, if left to themselves, 
or are aggravated by irritating or alcoholic articles, 
change their type sooner than mild ones, and are 
more likely to show symptoms of congestion or a ty- 
phoid gangrenous condition in their progress; such 
i was often the case in the great epidemic which pre- 
vailed in 1812 and 1813, when, either by the na- 
tural run of the disease or from the exciting stimulat- 
ing remedies used, the vital organs were frequently 
obstructed, the blood was forced into the brain or 
lungs, congestions of those parts took place, and in 
many instances a sudden and fatal termination was 
the result. 

During the prevalence of the great epicfemic from 
1811 to 1815, which was generally of a pneumonic 
character combined with remitting billions fever, 
though it had many other names, and in many cases 
affecting the throat like quinsy, an opinion exten- 
sively prevailed that the cases were at fiist of a 
typhus or gangrenous nature and this belief led to 
the use of mercury, cordialds, spicery and alcoholic 
prescriptions to ward off tlie typus^ and to heep the 
system from running down into a typhoid or gan- 
grenous 01' mortified state!''' Under the influence of 
such a course of treatment the disease proved to be 



3 

alarmingly fatal ! in many places the deaths being 
nearly or quite one half of the whole number treated. 
On the other hand, notwithstanding the disease 
evinced a disposition to assume a typhoid condition 
when means were not early used to remove the con- 
gestion or inflammatory state, and particularly so 
when alcoholic articles were early used; it was found 
that })y a moderate use of blood letting and an anti- 
phlogistic sudorific course of treatment in the early 
stages, about nineteen out of every twenty cases were 
cured. About three hundred cases were treated by 
the author. 

Authorities for these statements are contained in 
my history of that epidemic, as it prevailed in 
Dutchess County ; also similar statements are made 
and corresponding results are given in essays on that 
disease by Surgeon General Mann, Hospital Surgeon 
Lovel, Professors Gallup, Hosack and Francis. In 
all of these works it is stated that by moderate bleed- 
ings and a cooling refrigerant course of treatment at 
first, al)out fifteen in sixteen were cured ; and that 
by a free use of stimulating exciting and alcoholic 
articles early used, a large proportion, and in many 
places one fourth, one half and more of the cases 
were fatal ! 

After the inflammatory and congestive state was 
removed in the eai-ly stage of the case frequently a 
free use of supporting and stimulant treatment was 
indicated, and proved very beneficial. 

During this epidemic Dr. Samuel Bard, who at 
the time of his death was president of the oldest 
medical college in this city, had a severe attack of 
it, which affected the chest ; but the force of the 
disease siezed on the throat, like suffocating quincy, 
for which I bled him freely twice in twelve hours, 
which arrested the disease, and in four days he sat 



up and soon was out. He lived in tlie enjoyment of 
good health about ten years afterward. 

When the late Dr. David Hosack resided near the 
city of Poughkeepsie, his wife, who was subject to 
asthma, had a severe attack of asmatic pneumonia 
and quincy ; the oppression and difficulty of breath- 
ing was great; Dr. H. said she would most likely 
die. Having been House Doctor to the N. Y. Alms 
House Hospital while Dr. Hosack was Visiting Phy- 
sician there, and a long time under his tuition, he 
had a favorable opinion enough of me to call for my 
aid in the treatment. By his consent I took a large 
portion of blood which gave great relief and checked 
the disease — by subsequent treatment she recovered. 

In 1825 a disease prevailed of an epidemic charac- 
ter along the Hudson River and extending into many 
districts of country. It was of a remittent congestive 
nature, inclining to or assuming a typhus character, 
and frequently in the beginning there were active 
inflammatory symptoms. In the treatment some 
practitioners rather freely used bleeding and refri- 
gerant sudorific means — those cases generally got 
a crisis by the ninth day, and as far as was known 
they all recovered. 

A large portion of other practitioners avoided 
bleeding — gave calomel, opiates, sudorifics and cor- 
dial stimulants, to which were added alcoholic arti- 
cles. Many of these cases, as reported, became obsti- 
nate, protracted to three, foui', five or six weeks — 
they passed into a typhoid or typhus state — many 
of them proved to be fatal. — See Appendix. 

During the prevalence of the epidemic cholera, 
which was shown by post-mortem examinations and 
other ways to be attended with inflammation of the 
villous coat (inner surface) of the stomach and ali- 
mentaiy canal and congestion of the lungs, — Dr. 



Donafdson states, "I have ascertained that in those 
cholera fluxes there is inflammation of the villous 
coat of the alimentary canal, and that by active de- 
pleting means to cure such a condition of disease 
they might be directly cured." 

In desci'ibing simple inflammation of the villous 
coat of the alimentary canal without regard to an 
epidemic, Dr. Abercrombre gives symptoms similar 
to a violent case of cholera — he directs bleeding for 
it. Dr. Bey, Physician to the Pacha of Egypt in 
1832, where the cholera prevailed with great violence, 
took small portions of blood and repeated the opera- 
tion, gave water freely and a little opiate, but no 
other medicine, by which nearly all were cured — the 
people adopted this mode, and in numerous cases 
cured themselves. 

British Consul . General Baker to Egypt, in 1832, 
had the dii-ection of a large number of cases of cholera ; 
when the men were taken their feet were set in warm 
water, a vein was opened in each leg, the blood 
flowed into the water about fifteen minutes — he gave 
water freely, but no medicine, all those recovered. 

Broussais and Cruvilhier of France, Bell 'of Phila- 
delphia and many others, adopted this theory, and 
treated the disease in a similar manner with great 
success. 

In this epidemic there was a great inclination of 
the people, and by a large portion of the medical 
faculty, to use astringents, cordials, spicery, opiates and 
alcoholic mixtures — under their influence it was very 
mortal. Reports stated that one-half and more fre* 
quently were fatal. 

The plan for treating it in 1832, detailed in my 
history of it, was founded on the theory that there 
was villous inflammation of the alimentary canal and 
congestion of the vital organs; the result was as is 



6 

shown by a record in that work, of one hundred 
and twenty-five well formed cases, one hundred and 
nineteen of them (ninety-five per cent.) were cured ; 
the leading remedies at first were bleeding, cold 
water and ice. There were here and in other instan- 
ces about two cases in the premonitory state pre- 
scribed for to one of the fully formed. 

For the epidemic of 1849 in New York, a similar 
general mode was followed ; by the use of homoeo- 
pathic medicines, aided in the severe sases by blood- 
letting — a record made at the time shows that in 
two hundred and sixteen cases, ninety-eight per cent, 
were cured. 

From experience during four seasons of managing 
and observing this epidemic, and in witnessing it in 
various states and stages of about two thousand cases, 
some important conclusions are made : 

1st. — The violent symptoms of vomiting and spasms 
are soon checked by blood-letting. 

2nd. — There is no disease which is more readily 
and beneficially affected by abstraction of blood 
than Epidemic Cholera. 

8rd. — From the burning pain of the stomach and 
great thirst, the patient desires a constant use of 
cold water or ice. 

4th. — The small, flaccid and almost imperceptible 
pulse at first, on the abstraction of blood, becomes 
naore full and firm and the strength of the patient 
increases. 

The first case of epidemic cholera I ever saw was 
in the City of Poughkeepsie in July, 1832, it was a 
violent prostrated collapsed case, with i-apid watery 
evacuations, the skin and tongue was cold, the eyes 
sunk in, the pulse small, tremulous and flaccid, spasms 
severe — by six small bleedings of three or four ounces 
each, with other means, in forty-eight hours he was 



in a fair way of cure, and soon was well — after every 
abstraction of blood tbe pulse became fuller and firm- 
er, and the blood increased in florid ness and vitality. 
This was a pioneer case which lead to a decision on 
a plan for treating that epidemic; this case is recorded 
in my work mentioned at page 84. 

In the fall of 1849 the Homoeopathic Society of 
the City appointed a committee to ascertain the suc- 
cess of that mode of treatment; they reported that 
from the best infoi-mation they could obtain, about 
ninety per cent, were cured. 

About the same time the Board of Health made 
a report to the Common Council on the epidemic, by 
which it appeared, that in the Hospitals there were re- 
ceived about two thousand patients where they had 
all the conveniences for" comfort, nursing and means 
of cure. It also appeared the remedies used were 
of a high stimulating nature; the number were forty- 
six per cent, only cured. 

In an essay on the sore throat disease as it pre- 
vailed in Albany in 1859, read at a meeting of the 
National Homoeopathic Institute by Dr. H. D. Paine, 
the following remarks are made: 

" In severe cases there is violent infiammation of 
the glands, also of the tonsils, and uvula extending far 
back in the throat, accompanied by a more or less 
formation of a membrane of a dull white color ; the 
attack is frequently ushered in with rigors and 
chills, pain in the head and limbs, with general feel- 
ino- of depression ; before the occurrence of the 
membrane there is intense inflammation. Deglu- 
tition is generally very painful and difficult, the 
fever runs high and is followed by a stage of depres- 
sion^ in general the more vigorous and healthful the 
subject the mor^ decided will be the excitement." 



8 

As tte disease appeared in the city of New- 
York in 1859 and 1860, very similar symptoms were 
presented. The inflammation affected the glands, 
the tonsils were inflamed, swelled and ulcerated. 
In some cases abcesses formed in the throat, in 
others the lining membrane of the windpipe was 
inflamed producing cynanche trachealis (quinsy of the 
windpipe erroneously called croup), in other cases 
all these parts were affected at once; in some cases 
a thick spurf appeared on the parts. Sometimes 
the inflammation extended into the lungs forming 
pneumonia, the muscles of the neck were swelled, — 
gangrene or mortification did not take place in any 
case in ray care — some cases had a thick scurf on the 
inflamed parts, i-esembling shammy leather from 
which symptoms it seems the disease has been call- 
ed diptlieria. The mode of treatment pursued no 
doubt prevented the progress of the cases so as not 
to I'un into such a state called diptheria. 

It is an erroneous use of names to call a disease 
after a symptom which may or may not appear. 
Simple epidemic quinsy would do much better, it 
conveys a pathological idea of the nature of the 
disease, and would indicate a mode of treatment, 
In Webster's Dictionary quinsy is defined inflamma- 
tion of the throat. 

Dr. Willard of Albany, in describing this disease 
states that " there is a diffusive inflammation of the 
throat;" — "a high degree of inflammation of the 
parts and fever" — "the congestion extends to the 
cellular vessels" — "the tonsils were so inflamed and 
swelled so as touch each other." 

Dr. Preston of New Bi-unswich states, " that at 
the attack there was generally. a high inflammatory 
fever." Again, "there was inflammation and en- 
largement of the tonsils and glands of the neck." 



9 

Tressier of France states "that the disease is 
characterized by inflammation of the parts, and in- 
flammatory fever; it is cdWed phlegmar&ia,''^ (inflam- 
matory). 

In Professor Clark's Lecture on this disease, it is 
stated, "in diptheria there is such forms of inflamma- 
tion as terminate in a membrane in the throat," — 
"the membrane is preceded by and is the result of 
inflammation of the throat;" "the throat is inflamed 
before the ^membrane forms;" "the disease begins 
with chills and fever; when it locates on the traclaea 
there is ct'owp ;" " the breathing is difficult ;" " the 
surface of the face and body frequently is purple or 
blue;" (showing that there is congestion and a de- 
oxydated state of the blood,) " there is uniformily 
inflammation and swelling of the glands of the neck 
and throat." 

From such a group of symptoms at the beginning 
of a disease it is evident that its general character is 
of an inflammatory nature, and it would seem to be 
an advisable way to treat it as an active inflam- 
matory disease. In such cases all the train of symp- 
toms which follow depend much on the treatment in 
the first stage. In my Essay on the Epidemic of 
1812, it is said: "The symptom^ which appeared in 
the progress depended upon the treatment at first. 
When antiphlogistic means were used to check the 
inflammation and depression at first, the case was 
often mild and soon controlled; but where those 
agents were neglected, or such used as would aggra- 
vate it, such as mercurial, opiates, irritating and stim- 
ulating alcoholic articles, the disease often became 
unmanageable, typhoid, gangrenous and fatal." The 
same course of treatment by stimulating acrid arti- 
cles with similar results often took place in epidemic 
cholera. 



10 

In a report made by Dr. Ramsay, from the Inspec- 
tor's office in this city for February, 1861, in the 
mention of diptheria, it is stated " that the term has 
come into use in this city wonderfully within the 
last year, and four hundred and twenty-two deaths 
are reported from it. The name of this disease 
(symptom) in nosology is adopted from the French 
in reference to the characteristic membranous exudi- 
tion in the throat. 

In the Report of the City Inspector for the year 
ending Jan. I, 1862, there are set down from this 
throat disease nine hundred and twenty-six deaths. 

In England, in 1858, such a disease prevailed ex- 
tensively, when it was called throat disease, which in 
plain English is rendered quincy, as I have hereto- 
fore stated. It appears clearly that the membra- 
neous formation in the throat, erroneously called 
diptheria^ is the effect of intense inflammation which 
has not been checked in the early stages of the case, 
which probably might have been prevented by 
proper and active treatment. 

Dr. Ramsay, also Dr. Gallup and Dr. Mann, state 
that when an unusual disease appears with violent 
symptoms there are hard or new names attached to 
it, such as are represented to be incurable ; it relieves 
the prescriber from unfavorable remarks and a charge 
of gross error on account of the unsuccessful treat- 
ment. 

During the epidemic cholera in 1832, in some in- 
stances it was stated that it could not be cured. In 
two villages in my vicinity, in 1832, the people were 
thrown into alarm and consternation by being told 
by medical men that it was incurable. 'Their decla- 
rations were confirmed by their treating six or eight 
patients in each place, and they all died ; when the 
uniform success in other cases, by different treatment 
proved the fallacy of their declarations. 



11 

In the prevailing throat disease it is a matter 
worthy of inquiry whether it might not be an im- 
provement in the treatment in the first stage to use 
somewhat active means to arrest the inflammation. 
It is admitted, as far as I have learned, that the 
mucous, or matter deposited on the parts, is the 
effect of inflammation, and it is 7iot the disease; and 
there may be a serious objection to call a disease 
after a symptom which may or may not exist. It 
appears that a tough exhudation is deposited on 
some pai-ts of the throat, resembling a piece of dress- 
ed sheep skin, or shammy leather, which is said tech- 
nically to mean diptheria — rather a queer, absurd 
name for a symptom by which to call a disease. But 
this is not the main objection to erroneous names, 
for it appears that with this term is connected the 
idea of gangrene, or that the case is prone to gari- 
grene or mortification^ or a depressed typhoid con- 
dition of the system. The unfortunate and fatal 
effects of treating a disease for a name instead of by 
the pathological condition has already been referred 
to in the remarks on the epidemic of 1812 and 1818 
and on epidemic cholera. Under such influences of 
a name it may be assumed that there is a gangrenous 
state taking place, and remedies are apt to be used 
to keep off gangrene or to prevent its effects, when 
really there may be no such state existing. A dis- 
ease attended with such symptoms as those above 
named would require an active depleting refrigerat- 
ing course of treatment, or a mode which is found 
best to check and cure such an inflammatory affection. 

For the severe cases as described above there is 
no remedy hiown which would be as useful as free 
depletion, which checks and controls such severe 
attacks more effectually than any other medical 
agent. 



12 

By early and prompt means to check sucli cases 
in the early stage, typhoid, gangrenous and a morti- 
fied condition is likely to be avoided ; also the symp- 
tom termed diptheria will not appear. Sir Astly 
Cooper says, " that by free bleeding present inflam- 
mation is relieved, and that the malignant sym/ptoms 
which would follow will he prevented^ 

By the following directions, gathered from the 
writings of Dr. Rush and Donaldson, patients have 
received great benefit. Thev say : " in violent dis- 
eases blood letting ought to be used early after the 
attack, before the blood assumes an iicrid, hot, gan- 
grenous tendency, and before congestion takes place." 
Without such precaution the rapid changes which 
the blood undei'goes in such cases may and does lead 
to a state of typhoid, gangrene and suffocating con- 
gestion or mortification. 

Patients situated as here mentioned have been 
treated according to this rule in hundreds of cases, 
and have had the disease arrested early and cut 
short in its progress — and in many instances by it 
persons have had their lives preserved: 

If the statements of Astly Cooper, Rush, Donald- 
son, &c. are correct, that in cases of intense inflam- 
mation, if not cheeked in the early stages, there is 
danger of serious and violent symptoms taking place 
— such as congestion and gangrene — and if the symp- 
tom called diptheria is a disposition to gangrene or 
something of the kind, it may be owing to a neglect 
of the use of eflBcient means in the early stages of 
the cese. 

In this exposition there is disclosed- the secret of 
the great ftitfdity of voilent and epidemic diseases, 
and there is also exposed the unfortunate and fatal 
error of the treatment in the early stage of those 
diseases by the use of stimulant and alcoholic reme- 
dies. 



13 

If adults should be severely attacked with this 
quinsy disease^ it would be advisable to take blood 
from the arm ; if the attack is not very severe, some 
common medicine adapted to the 'cure of such in- 
flammation will answer the purpose. In childhood, 
if the attack is severe, they would require a similar 
course of treatment, but if the attack is not very 
severe the remedies hereafter named will be quite 
sufficient to cure without bleeding^. Children are 
more prone to inflammatory diseases than adults, so 
they are much benefitted by having active means used 
to arrest such increased inflammatory action.^ How- 
ever experience has proved that a great majority of 
this throat disease may be cured without bleeding. 

When inflammation seizes the throat with violence, 
as it sometimes does, there is no time to loose by 
temporizing with inefficient means; the prescriber 
had better at once use active remedies so as to resist 
the invading foe. In many cases it would be advisa- 
ble to apply one or two leeches to each side^ of the 
neck over the tonsils — this would be particularly 
useful when blood could not be taken from the arm- 
in moderate cases this would answer the purpose, 
but in severe cases when the throat is swelling and 
fast closing up, it is better and safer to take blood 
from the arm at once. A child twelve years old and 
under would to advantage loose fi'om three to eight 
ounces of blood, and if the violence of the case was 
not checked in a few hours, the operation ought to 
be repeated. 

In the work by Broussais on Plegmasia (mliam- 
mation), it is stated that "it is inflammation which 
destroys the viscera essential to life, by which a 
majority of the human race perish— the most efficient 
remedy for this state is blood-letting." 

Marshall Hall states, "for inflammation, bleeding 
as a remedy ranks the first." 



u 

Professor M. Paine says, "that for inflammation 
and congestion, blood-letting is the most efficient 
remedy." 

Professor Morehead says, " there is no truth better 
ascertained than that for inflammation bleeding is 
the best remedy." 

When describing such a kind of disease, and par- 
ticularly so in pneumonia and congestion of the chest, 
the distinguished Dr. John Bell states, "if the patient 
is not relieved by a prompt loss of blood, they suffo- 
cate and die without a groan." Dr. Bard and Mrs. 
Hosack would have died in this way if active means 
had not been early used to arrest their diseases. 

If there should be a doubt about taking blood in 
such a case on account of weakness of the patient or 
compressible state of the pulse, a small portion can 
be taken at first, as I have stated, and was often 
done in the epidemic of 1812 and '13, and in epidemic 
cholera. When the pulse will rise and become more 
tull and firm, and the strength of the person increases, 
after this, if need be, the bleeding may be more full 
and free. It ought to be recollected that in such 
weakness in the first stage of disease, it is not from 
direct debility, but from depression, oppression, con- 
gestion, (more explanation of this hereafter). 

Here are introduced some extracts from Donald- 
son's History of Epidemics, by which the general 
character of those quinsy diseases will appear. 

In 1217 a violent epidemic quinsy prevailed in 
various places in Europe, a great many cases were 
fatal — " bleeding and cooling articles were the only 
remedies that cured it." 

In 1548, there prevailed in England and other 
parts, an epidemic quinsy and pneumonia, attended 
with suifocating depression — " blood-letting and re- 
frigent means was the only successful mode of treat- 
ment." 



15 

In 1617, there prevailed in New England and in 
other parts, an epidfraic quinsy (angina,) which in 
many instances was very fatal — "the only successful 
treatment was blood-letting and cooling remedies." 

In 1758, there prevailed in New England and in 
other parts, an epidemic quinsy and pneumonia, it 
was attended with great oppression and prostration. 
It was called winter fever. In many instances it was 
fatal. " The mode of treatment which proved most 
succetsssul, was bleeding" and refrigerating means. 
Many physicians opposed bleeding and their patients 
all died. 

This was similar to the pneumonia, or winter 
fever, described by Sydenham, which prevailed in 
England about 1785, for which he recommended ac- 
tive bleeding and refrigerant treatment, which proved 
successful. 

In 1798, a violent epidemic quinsy prevailed in 
many parts of America — " the only successful mode 
of treating it was by bleeding and cooling reme- 
dies." 

The epidemic pneumonia and angina which ap- 
peared in this country from 1811 to 1815 was said 
to be very similar to the pneumonia or winter fever 
described by Sydenham, in about 1685, the most suc- 
cessful mode of treatment for it I have already point- 
ed out. Within the last thirty years, angiiuis 
(quinsies) prevailed in our country a number of 
times similar in their natui-e to the one now prevail- 
ing, only there were not so many voilent ^ cases as 
now — they were all cured by the usual antiplogistic 
treatment. 

In many voilent cases of disease and particularly 
so in the epidemic affections, at the attack there is a 
small compressible pulse ; a great prostration and loss 
of strength ; a coldish doughy feeling of the skin ; a 



16 

lurid face ; a weight and pressure of the chest, and 
pains in various parts. In such a condition of dis- 
ease the people are always in favor of using cord- 
ial stimulating remedies ; also as reported a major- 
ity of medical prescribers have freely used such 
articles. The injurious and fatal effects of such treat- 
ment has been pointed out in the observations on 
the epidemic of 1812, also in the remarks on the 
epidemic cholera. From observations and informa- 
tion, it appears that such irritating and stimulating 
articles have been used for the epidemic throat dis- 
ease under consideration. 

In the published proceedings of the New York 
State Medical Society for 1859, there is an article on 
epidemic sore ttroat disease. In it there is recom- 
mended the use of caustics to the throat, and inter- 
nally quinine, iron, cordial and stimulant articles. 
Under such treatment it appears that in Albany 
there were 188 deaths. 

In Dr. Paine's essay it is stated that during that 
time, in Albany, almost all the cases which proved 
fatal were treated by a different mode than that by 
Dr. Paine ; and that including the stimulant articles 
there were over 250 deaths. The mode followed by 
Dr. Paine was said to be nearly successful. 

During the great epidemic which prevailed in 
London in 1665, by the use of hot steaming cordial 
and stimulating treatment 70,000 people were carried 
off — this was at the time when Sydenham enlighten- 
ed the medical world by his teachings. He raised 
his warning voice and moved his cogent pen against 
such a stimulant course of treatment. 

He recommended a free use of blood letting and 
cooling, refrigerating remedies ; which was followed 
in many cases with great success. 

Sydenham insisted that the disease was inherently 



IT 

of a high inflammatory nature, and attended with 
great depression, congestion and prostration; and 
that the malignant symptoms of a gangrenous, mor- 
tified disposition were the effect of those violent in- 
flammatory depressed synaptoms, and a hot acrid 
state of the fluids. 

A similar morbid condition of the system above 
mentioned was very common in the great epidemic 
of 1812 and 1813 — a small compressible pulse, at- 
tended with great depression, malignancy and a dis- 
position to mortification. Such symptoms are noticed 
by Surgeon General Mann, Dr. Gallup and others. 

In those states of depression and congestion which 
sometimes take place in the first stage of violent and 
epidemic diseases alluded to, the blood in a measure 
is stagnated in the lungs, or brain, or both ; in that 
situation it cannot receive (oxygen) vital air by 
breathing sufficient to support life — the blood be- 
comes deoxydated and black; the heart seems to' 
become paralyzed, and this was the opinion of 
Magendi of France. The heart is curtailed in its 
action, so as to be unable to propel the blood through 
the arterial system ; hence there is a small flaccid 
pulse connected with prostration, and if relief is not 
had soon by diminishing the fluids in the vessels and 
the pressure upon the vital organs, life will likely be 
soon suspended. 

In those states of depression, congestion and col- 
lapse, which were common in the epidemic of 1812 
and '18, and in cholera, — and sometimes such a con- 
dition attends the incipient stage of remittent fevers, 
when it is likely to be called typhoid, and by some 
modes of treatment runs into typhus, — in such cases 
prescribers have frequently used permanent and diff- 
usable stimulants. Those articles in such a state of 
the system strongly tend to aggravate the disease 



18 

and hasten the fatal termination of the case. Frdin 
reliable information received it appears that such 
articles have been used for the throat disease under 
consideration. 

It is stated that the fatal cases under their influ- 
ence has been one in four; two in four; three in 
four, or more ; and that in some instances reported 
whole families of children have been swept off. 

In the history of the epidemic of 1793, by Dr. 
Rush, this kind of pulse and depression is described, 
and small abstractions of blood are recommended for 
it. By such a course of proceeding in a similar con- 
dition, many cases of the epidemic of 1812 and '13 
were cured. The epidemic which he wrote about, 
and the statements made of the success of his treat- 
ment in 1793, show that 95 per cent, were cured. 

In Dr. Rush's work it is stated, " that at a hospital 
fitted up for the purpose in the vicinity of Philadel- 
phia, there were received 807 patients, and that 480 
of them died. The remedies used were of a high 
stimulant nature — blood-letting was not among the 
prescriptions." 

It is claimed by Dr. Rush that by the good effects 
of the refrigerating treatment which he introduced 
in the epidemic of 1793 six thousand people had 
their lives saved. By the side of that statement 
stands a dark and gloomy list of over four thousand 
deaths. Very few of these had the benefit of Dr. 
Rush's plan of treatment — they were subjected to 
the stimulant remedies. 

Such a depressed, flaccid state of the pulse as has 
been mentioned, was very common in the epidemic 
cholera. It is an evidence in such a state of dis- 
ease, of congestion, or morbid pressure of the blood 
upon the vital organs. It has been represented that 
a similar depression and compressible pulse has been 
observed in the prevailing epidemic quinsy. 



19 

When the throat is severely inflamed and swelled, 
as it is in quinsy, a mucous matter forms on the 
parts — the disease sometimes locates on the mem- 
brane lining, the upper part of the windpipe ; then 
it is termed croup. In some cases, the passage for 
the air to the lungs is closed — the air to support life 
is cut off; this may be an immediate cause of death. 

From a memorandum of an interesting case, a short 
extract is made. At Rhinebeck, Mr. Schell, the 
father of the late Collector of the Port here, had a 
severe attack of quinsy ; the throat was intensely 
inflamed and swelled. After all had been done, 
thought advisable by three doctors, without success, 
the patient was given up to die, and was painfully 
struggling for breath, when the author of this essay 
was introduced, who discovered that the passage was 
closed up for air to the lungs ; when he passed a 
sharp pointed instrument into the throat, and, by a 
quick movement, cut freely through both tonsils ; 
the blood issued copiously, the swelling immediately 
subsided, the air rushed into the lungs, the breathing 
soon became free, the patient was calm, and in a few 
days he was at his business. 

In some cases in the prostrated state of cholera, 
when there was congestion of the lungs, I have 
frequently seen patients struggle and labor for 
breath • but they were sometimes situated under 
care of another doctor, so that the remedy which 
might have relieved them could not be used, and 
shortly the vital principle made its exit. 

It is stated by Dr. Rush, Sir Astly Cooper and 
Rroussais, that in those states of depression which 
takes place in epidemic diseases, and particularly so 
in epidemic, pneumonia, cholei'a and quinsy, that 
when reaction begins to take place, then it is proper 
to bleed. With diffidence and great respect be- 



20 

fore such authorities, I take leave to state that 
from my observation in cases where there is great 
prostration at the attack, with collapse when the 
blood has receded from the vessels at the skin and 
collected in the lungs and other vital parts, and the 
heart is almost suspended in its action, if the prescrib- 
er waits for reaction to take place before useing 
means to give vent to some of the stagnated blood 
in the vital organs, he will probably wait until life 
ceases to exist. It is more likely that by a prompt 
abstraction of some of the blackish deoxydated fluids 
which will relieve the heart from the morbid pres- 
sure upon it, so that it can act more freely to pro- 
pell the fluids through the arteriel system, by which 
the blood, in passing through the lungs, receive an 
increased portion of vital air, and by which reaction 
is aided and more likely to be brought about. Then 
the pulse becomes a little more and more full and 
firm, until fair reaction is established. 

The preceding observations and facts are gathered 
from various authors, and my own observations and 
experience. 

It is gratifying to be able to state that by the 
homoeopathic method, diseases may be cured without 
abstracting as much blood as it has been considered 
advisable and necessary by the former system. But 
it is evident that there is great danger of running 
into an opposite extreme by raising unreasonable ob- 
jections to its use, or by totally rejecting it, as some 
have done and are doing. This remedy, blood- 
letting, has held a prominent position in curing 
diseases in thousands of cases, and there are abund- 
ance of facts to show that multitudes of persons have 
had their lives terminated by an opposite course of 
treatment when it has been rejected. 

It is a matter of serious consideration whether it 



21 

is advisable or justifiable to reject the use of a 
medical agent which for centuries has held a promi- 
nent position in curing violent and epidemic diseases. 
Cases do occur when an abstraction of blood, com- 
bined with homoeopathic medicine, will be essential 
to the welfare and safety of the patient. In some 
such violent cases as have been referred to in the 
preceding observations, when the vital organs are 
seriously affected and changes in the qualities of the 
blood, which soon take place in such states of high 
inflammation and congestion, the rapid progress of 
the disease is too great to be arrested by any known 
medical agent, quick enough to prevent danger and 
great injury, which would soon ensue, short of 
lessening the quantity of fluids and morbid pressure 
upon the parts, and are acting as the exciting agents 
to aggravate the case. 

From observations and information received, it 
appears that patients sometimes fail to recover by 
the exclusive use of homoeopathic medicine, who 
probably might have been moved by a judicious use 
of blood-letting in the early stage of the case. 

The distinguished Sir Astly Cooper says, _ " in 
those severe attacks of disease the piflse is sometimes 
small and flaccid ; then wait awhile ; often reaction 
begins to take place ; then bleed freely, and by it 
the pulse raises and becomes more full and firm. 

Among the cases recorded in my Essays on Cholera 
there is one of a female, in 1832, who had a violent 
attack of the disease with watery evacuations and 
great prostration ; the pulse was scarcely percepti- 
ble ; she was bled three times ; three or four ounces 
were taken from the arm at a time, when reaction 
came out, aud with such activity that she was re- 
quired to be bled three times again, moi-e freely, 
before the increased action was subdued. In all, she 



22 

lost over 10 ounces of blood ; slie soon recovered, 
and enjoyed good health. 

Among the people, and sometimes by the medical 
fraternity, there is prevailing an injurious prejudice 
against taking blood, urging that it produces weak- 
ness and lasting injury ; frequently obstinate objec- 
tions are made to it. This opinion is veiy erroneous, 
and its influence has been a means of destroying the 
life of a great many people. On the att^k of violent 
and epidemic diseases, the weakness then is from 
congestion or oppression, the circulation of the blood 
is impeded in the vital organs. In such cases, on 
abstraction of blood, the heart and arteries are 
relieved, and the inflammation is checked, the patient 
directly gains strength, and frequently, from being 
unable to raise in bed, will get up, walk the room, 
and help himself. For this we have the authority 
of Dr. Rush, in the epidemic of 1793, of Mann and 
Gallup, in the epidemic of 1812, and which I have 
frequently seen. Such occurrences frequently took 
place in epidemic cholera. \ 

But when it is proposed to give the patients 
alcoholic preparations, it is readily assented to by the 
friends of the patient, and they will freely dose 
largely with alcoholic mixtures. From observation 
and information obtained, it may safely be stated 
that dozens of persons have had their lives termi- 
dated by the use of those stimulant alcoholic biba- 
tions, where one has been injured or died from a 
judicious bleeding. Statements of this kind have 
often been made in temperance lectures, particularly 
in those showing the injurious and fatal effects of 
alcohol in states of disease, 



Mode of. Treatment 

FOR THE 

EPIDEMIC THROAT DISEASE. 



'It is reasonable to infer that the doctrines, the 
statements, and the use of such remedies as have 
been successfully used in former epidemic diseases, 
which have been referred to in the preceding obser- 
vations, will apply to the nature and treatment, of 
the epidemic sore throat disease prevailing. 

When acute inflammation locates on the brain, 
lungs, stomach, bowels, &c., it is well understood 
that active means to check it is the most advisable 
course to pursue — when the inflammation locates on 
the throat, there is an additional danger attending 
it that the throat may soon swell, and in a measure 
close up the passage of air to the lungs, and this 
makes it important to check the progress of inflam- 
mation as soon as possible. 

This disease is said to be attended with intense 
inflammation of the throat. Then why not use such 
remedies for it as ^have been successfully used in 
other cases of intense inflammation? They have 
been fully pointed out in the preceding observations. 
It is agreed by writers that there is a severe 
inflammation of the parts before the symptoms of 
gangrene or diptheria appear. Then, by the teach- 
ings of Rush, Donaldson and Sir Astly Copper, if 
the inflammation is thoroughly checked in the first 
stage of the case, there would probably be no gan- 
grene, leather, sheep skin like formation m the 
throat, or diptheria to treat. 



24 

If the term di'ptheria could be abandoned and tbe 
disease called by its more proper name, quinsy^ a 
favorable move would be made t^oward a course of 
treatment. Remedies are apt to be associated with 
names which frequently are very erroneous and lead 
to unfortunate treatment. Dr. Rush says even the 
genius of Dr. Cullen could not make diseases march 
in right lines to follow names. 

If it is decided that the throat disease is of an 
inflammatory type, then all articles of an exciting or 
stimulating nature ought to be avoided, and such 
used in the early stage as are best adapted to check 
and cure an inflammatory state of the system and 
the throat, and, if it should be present, to remove 
congestion. 

From the preceding statements, it is presumed 
that a mode of treatment for the prevailing epidemic 
sore throat, distemper, or quinsy, will be indicated, 
so as to adopt a method of treatment which will 
prove successful. 

If the nature of this disease is clearly and correctly 
pointed out, and the indications for cure made plain, 
then those who have, different opinions about the 
medicine to be used, will not find it difficult to apply 
means so as to be attended with success. 

Pn addition to what has been stated, here is given 
an outline of a mode of treatm'ent ; but prescribers 
likely will use such medicine as they may be partial 
to, and in accordance with a favorite system. 

The mode which has mostly been followed by me, 
has been in accordance with the homoeopathic plan ; 
the remedies used were No. 2 of the homoeopathic 
preparations, and sometimes of higher attenuations. 
They were aeon., bell., ipecac, anti., bryo. In most 
cases these medicines, ^vith the other means men- 
tioned in this essay, were sufficient to effect a cure. 
The following mode will be the way to use them : — 



^5 

Ipecac. — When there is nausea or vomiting, begin 
with this. Put 3 grains of the powder or 10 drops 
of the liquid dilution into a half gill of water ; give 
the child a teaspoonful every 15, 20 or 30 minutes 
for a few times, when vomiting will likely he allayed 
or checked. 

Anti Tart will answer the same purpose, if pre- 
pared and used in the same manner. If there is 
fever and swelling of the throat, without nausea, 
begin with 

Aeon. — Put 5 grains of the powder or 10 or 15 
drops of the dilution into a half gill of cold water ; 
give a teaspoonful every 1, 2 or 3 hours ; or, if the 
nausea continues, this may be alternated with ipc. or 
anti. If the tonsils are considerably swelled and 
red, use 

Bell. — To be prepared and used as is directed for 
aeon. This is specific for some forms of quinsy ; this 
may to advantage be alternated with aeon or ipc. 
It is thought advisable not to continue bell over 48 
or 60 hours in quinsy or scarlet fever. After the 
preceding course, 

Bryo will be a very good medicine ; to be pre- 
pared and given as above directed. If the inflam- 
mation and swelling is severe, apply leeaches to- the 
neck, over the tonsile or abstract blood. 

Baryta. Curbo. — After the preceding course and 
the tonsils are sore and enlarged, this is a very good 
remedy ; to be prepared and given as directed for 
the other medicine. 

Iodine will be very useful for the same condition 
of the disease. 

Ammo. Carb. — When there is a ropey mucus 
forming in the nose or throat, or has formed, as it 
sometimes does in quinsy and in scarlet fever, this 
will be a very useful medicine ; to be prepared and 
given as directed for the other medicine. 



26 

Iodide of Merc. — In the progress when there is a 
tough mucus formed in the throat, and there is a 
swelling of the tonsils and glands of the neck, this 
would be a very useful and an efficient medicine. 

Iodine. — When the throat is swelled, and there 
has formed in it and on it a tough coating of a mem- 
branous nature, this has been used with much benefit. 
Mode of using it : — Put 5 drops of the tincture to a 
half gill of water ; give the child a teaspoonful every 
15, 20 or 30 minutes on to an hour. By this means 
the membranous scurf has been detached, and came 
away, or may be taken away, so that the child has 
recovered. 

Several other medicines have been recommended 
and used with good effect — such as bromine, rhus. 
T., ars., chamo., &c. The time and manner for using 
the medicine is more fully laid down in the "Family 
Physician," and in other Repertories, under angina, 
croup, scarlet fever, inflammation, &c. 

But there are some rules which it is advisable and 
important to observe, as connected with any mode 
of treatment. At the first stage of a case, avoid 
applying blisters, liniments, or any irritating or 
exciting article to the .neck, and of giving any kind 
of irritating or stimulating article internally ; keep 
the patient in a cool room and lightly covered ; don't 
let him breath hot air nor take hot drinks. It is to 
be borne in mind that these articles pass directly 
over the affected parts, and they tend to aggravate 
the disease. Use no irritating articles in the throat; 
it seems to be an absurd and injurious practice to 
swab an inflamed throat with infusions of cayenne 
pepper and such kindred articles, which it is said is 
sometimes done, and it answers very little purpose 
to attempt to cure a violent inflammation of the 
system, which has located on the throat by some 
feeble or injurious application to the part, and equally 



27 

unadvisable to torture a child by using caustics to 
the throat ; when there is a state of high inflamma- 
tion of the parts, caustic will likely increase the 
disease. A substitute here is suggested for caustics : 
— When the throat is inflamed and very much 
swelled and likely to be closed up, scarify the tonsils 
freely, so as to have the blood flow as much as it 
will; then the inflammation and swelling may at 
once subside, and the disease be arrested ; give the 
patient as much cold water or ice as it will take ; 
apply a cloth wet in cold water to the neck, and 
change it often. The writer has not in any case 
used gurgles, except cold water, nor caustics to the 
throat, nor given emetics. When the throat and 
tonsils are inflamed and swelled, so as to almost close 
the passage, the disease cannot be vomited out ; the 
effort to vomit is apt to close the parts, and the 
patient may die in the effort or soon after. I have 
known of some cases, and heard of others, which 
have been fatal in this way. Such remedies are of 
doubtful utility, and may do great injury. Let the 
patient be kept cool and calm. Should gangrene 
take place, it is time enough then to treat it ; the 
remedies for it are well understood ; the author has 
not yet had occasion to use them. 

As an evidence of the correctness and utility of 
the theory and practice detailed in this essay, it is 
stated that in 1859, there were a large number of 
cases of sore throat disease came under the author's 
care. They were all cured of the disease of the 
throat ; one had a secondary general dropsy ; it 
lingered about two weeks and then died. 

Since the first of January, 1860, a large number 
of cases of the throat disease, many of them very 
violent, have come under his care, which, added to 
those of the first year, would make a very large 



28 

number, some hundreds; with only two exceptions, 
they all recovered. 

In conclusion, it is stated that by the general 
method of treatment which has been detailed for the 
epidemic quinsy, has been applied and used for the 
scarlet fever • and when it has been fairly used and 
properly followed, modified according to peculiar 
symptoms, it has invariably proved successful. For 
over four years there has not, under this mode of 
treatment, been a case fatal. 



APPENDIX. 



The remittent fevers, which prevails during the 
seasons of Summer and Autumn, in the first stages 
of the cases, are generally of an inflammatory, or a 
congestive, or a compound inflammatory nature. In 
most instances depleting or refrigerant treatment, 
until that state is removed, will be of great service 
and importance to check the disease, and will be a 
means of preventing a state of typhus fever taking 
place ; and also of curing the patient, when stimu- 
lants are excluded, in a much less time than those 
cases are frequently cured by other means used. A 
great many years of observation and practice, and 
by treating and curing hundreds of cases, justifies 
these statements. 

The following remarks in substance are taken 
from a published collection of sketches of histories 
©f epidemic diseases, which I have collected at 
various times. This was read at the Annual Meeting 
of the Dutchess County Medical Society in October, 
1825, as a valedictory ofiering of the retiring presi- 
dent. The remittent and typhus fever has prevailed 



29 

in an epidemic form in our county and along the 
Hudson River, during the past season, with great 
severity and in numerous cases. Generally it has 
been ushered in with acute inflammatory symptoms ; 
but in many instances, there was a small flaccid 
pulse, like that which was often presented in the 
great epidemic of 1812 and '13. There was a dull, 
pressing headache — a dull appearance of the eyes — 
a lurid face — a tired, aching of the limbs — the 
tongue was contracted, pointed and red, with lively, 
red eyes — in some cases there was great prostration.* 
When the disease was not checked early, a state of 
typhus was likely to set in, which might be and 
was, in some cases, tedious,' protracted and fatal. 

* This appearance of the tongue is an evidence of an inflamma- 
tory condition of the system, and as long as it continues in a case, 
it is an admonition to avoid the use of stimulant alcoholicar tides. 
This was an indication which influenced Dr. Rush to adopt a 
depleting course of treating the epidemic of 1793. It was a 
beacon guide for the use of blood-letting and refrigerating remedies 
in the epidemic of 1812 and 1813. During the epidemic cholera, 
in collapsed prostrated cases, when reaction was brought about and 
the case became somewhat protracted, this appearance of the 
tongue often was presented, which furnished an objection to the 
use of stimulant alcoholic articles. Let the advocates of stimu- 
lants in such states of disease, reflect with remorse and shame, how 
many patients they have sent over to the undertaker, while prac- 
tising against depletion on one side and pouring stimulant alcoholic 
mixtures down the throat on the other. 

The treatment which proved most successful was, 
in the early stage, to use active means to remove the 
congestion and inflammatory state ; for this purpose 
blood-letting was the most useful remedy. The 
succeeding symptoms were shaped by the use or 
omission of this remedy. In those cases where there 
was great depression or congestion, and the pulse 
was flaccid, as it generally is in such states of disease, 
the portion of blood taken at first was small, and 



30 

sometimes the operation was repeated, as was prac- 
tised in the epidemic of 1812, and in that of 1793, 
as was recommended and used by Dr. Rush, in such 
a condition the pulse on bleeding became more full 
and firm ; the medicine used was of a refrigerating, 
sudorific nature ; the fever run out and a crisis 
formed by the ninth day ; there was no stimulants 
given till after the crisis, and very little then ; 
nourishment was mostly relied upon to restore the 
strength. Some of the cases passed into a typhoid 
state ; but on account of the early management, it 
was soon controlled by this treatment. There was 
not one case fatal. In many instances and in various 
places, from reports made and information received, 
attempts were made to cure this disease by the use 
of alexipharmic remedies, such as mercury, opiates, 
sudorifics, cordials and alcoholic mixtures, and those 
were given in free large doses. Generally a long, 
tedious sickness ensued — the case run along for 3, 4, 
5 or 6 weeks — the patient got a black scurf on the 
tongue and teeth — then came on stupor, delerium, 
nervous irritation, spasms, and a train of those symp- 
toms called typhus. A large portion of such cases 
terminated in death ! ! 

There is an account given by Dr. Donaldson of a 
remittent bilious fever which prevailed in the City 
of New York in 1822. It was of an epidemic cha- 
racter, and disposed to be very malignant. He 
states that it had severe inflammatory or compound 
inflammatory symptoms — that he treated a large 
number of cases by free blood-letting and refrigerat- 
ing remedies, and that 19 in 20 cases were cured. 
It is added — "A large number of my neighbor prac- 
titioners objected to bleeding ; they gave calomel 
and exciting anodyne sudorific medicine and alco- 
holic articles. Those treated in this manner half died." 

About 1830, an address on remittent and typhus 



^1 

fever was read by Dr. Maygel, in Albany, to tlie 
New York State Medical Society, in which it was 
argued that in this country those fevers in the first 
stage of the cases, were of an inflammatoiy or com- 
pound inflammatory nature — ^that unless tnis condi- 
tion of disease was releaved or checked in the early 
stage of the case by antiphlogistic remedies, a 
typhoid, protracted state was likely to ensue. This 
is similar to opinions contained in Armstrong's 
" Treatise on Congestive and Typhus Diseases," and 
the antiphlogistic practise in the first stage is recom- 
mended by him. 

In 1856 there \yas a severe epidemic^ remittent 
fever prevailed at the Quarentine on Staten Island 
and in the vicinity. From a description of it, there 
appeared to be attending in it inflammatory conges- 
tive symptoms. It was understood that there was 
very little or no depleting remedies used for it, but 
those of a stimulant nature. In a report on it, made 
by the Quarentine Doctor to the Legislature, in 
January, 1857, it was stated that there were "re- 
ported 538 cases, and that more than one-third of 
them died." 

Cases of remittent fever, sometimes becoming 
typhoid similar to those detailed, have taken place 
at various periods, and a number of such have 
occurred lately, which have terminated very dif- 
ferently under different modes of treatment. Some 
of them were of importance enough to accupy a 
place here. From a number, all treated alike and 
all cured, one is selected : — 

1861, December 20th, R. I. took cold ; the effects 
increased, so on the 20th he was confined to bed 
with fever. 1862, January 1st, I first saw him, 
when he was prostrated — dull pressing headache — 
tired, aching pain of the limbs — pressure of the chest 
— tongue pointed and red edges — pulse flaccid— 



32 

liiind impaired — general symptoms of congestion. 
From the arm sixteen ounces of blood was taken, 
after which the pulse was more firm and regular. 
He was given cold water freely ; homoeopathic medi- 
cine only was given. From this time the symptoms 
abated ; the mind was more correct ; the medicine 
was changed to the prominent symptoms ; he was 
confined to the use of cold water and gruel, all 
irritating and stimulating articles were excluded ; 
the fever and disease abated. On the 10th of Jan- 
uary the fever subsided, and a crisis foi'med ; on the 
12th he sit up ; from that he daily walked the room ; 
there was no stimulants given ; used merely nourish- 
ment ; on the 20th he went out of his room fully 
cured. 

Within my knowledge, about the time of the pre- 
ceding case, a number of others of a similar character 
took place, which were reported by those who 
attended, so that a very correct account was obtained. 
It appears that they were treated pretty freely by 
stimulant articles and without depletion. One as a 
sample is selected from a number : — 

Mr. was attacked with a cold, and in ten 

days he took to bed, with symptoms similar to those 
of R. I. In four days he was prostrated and very 
much distressed — fever high, tongue red and pointed. 
It was now stated that he had typhoid fever. There 
was given beef tea, and soon after a free use of wine. 
The patient became indifferent — inclined to stupor 
— was very uneasy — a black scurf formed on the 
teeth and tongue, the edges of the tongue retaining 
a florid red — he was prostrated — to keep him from 
sinking and running down, the wine was increased 
and brandy was added in free portions — he became 
very uneasy — the mind was impaired and deranged 
— nervous irritation came on. In this manner, he 
struggled along five weeks, then died ! 



1